APPLICANT'S ABSTRACT: The recent report of the National Advisory Council on Alcohol Abuse and Alcoholism, Subcommittee on Health Services Research, recommended that NIAAA support research that focuses on the "dimensions of setting, modality, intensity, and treatment goals." The committee noted that stakeholders want to know more about the impact of different service delivery approaches for different individuals (i.e., What are the outcomes of different treatment modalities, for different types of clients, in different settings? What factors help to make treatment services effective?). In response to these questions, this NIAAA Small Grant Program project explores potential benefits to persons with alcohol dependence, from the application of a "setting-neutral" service delivery strategy (i.e., Assertive Community Treatment) with demonstrated effectiveness in improving treatment adherence for other NIH priority populations that present complex challenges to the service system. The sample population targeted in this study is predominantly rural, African-American, economically disadvantaged, and receives their care from "public" substance abuse service authorities in South Carolina. This application is directly responsive to USPHS goal of improving the effectiveness and efficiency of empirically validated services for disadvantaged populations 'at-risk' for inadequate outcomes of health, mental health, and substance use services with associated deterioration in community functioning. In health services research, the focus is on outcomes in practice settings and under typical rather than ideal conditions, that is, whether treatments that have been shown to be efficacious in controlled trials are also effective in real-life clinical settings. The investigators are an established, interdisciplinary public-academic clinical services research team affiliated with an academic department of psychiatry. They have developed excellent ongoing working relationships with substance abuse and mental health service; agencies in South Carolina. They have broad-based, extensive experience with the variety of current approaches to the community-based care of NIH priority populations. This includes experience with clinical service program implementation, as well as research including conducting numerous randomized trials addressing the effectiveness of field based outreach programs designed to maximize treatment adherence in NIH priority populations (both youths and adults) through intensive outreach efforts.